distractions, maximize capacity, create efficient entry and egress, and enable people to be easily found. Design considerations should also accommodate some radiologists’ preferences for private reading space, and others preferences for a more communal space. Movable, sound proof partitions made from translucent materials, in addition to having a variety of configurations radiologists can choose from, can address this need. As Dr. Chase Henson, Diagnostic Radiologist from North Mississippi Medical Center, in Tupelo, MS points out, “we needed to minimize unwanted distractions and disruptive foot traffic that can reduce radiologist productivity. We organized customizable reading spaces, along two long hall- ways, to enable us to be easily found by those who need us.”
Film, while all but eliminated for new studies, should be minimally addressed so that historical comparisons can be viewed. This can be accomplished by locating a few light boxes in a centralized area. More importantly, it is necessary to plan for ingestion of outside studies on DVD. Departments may manage this process centrally, in the file room, while others may leave the process to the radiologist or reading room support personnel. If the radiologist will be responsible for CD import, the PACS CPU must be accessible so the CD-ROM/DVD drive can be easily reached.
Subspecialty reading areas also have their own unique workflow and space usage requirements. Women’s Imaging, Nuclear Medicine, and Interventional Radiology, have often had their own reading space for consultation or participation in the imaging process, due to the need for radiologist proximity to the technologist and the patient. While these rooms are typically smaller, accommodating just a couple of radiologists, their efficient and inviting layout is no less important. In fact, the need for these spaces to support patient and physician consultations may be greater, requiring sufficient collaborative desktop space and the ability to review images with patients without disturbing other radiologists.
Regardless of the approach chosen, each space must balance the radiologist’s need to concentrate and eliminate productivity reducing distractions; while at the same time facilitate collaboration with specialty physicians and face-to-face consultation with patients. Whether driven by medicolegal decisions, or good business practices, radiology reading areas must facilitate and encourage radiologists to spend more time speaking to their customers in-person1. Simple changes such as removing the lock from the reading room door and posting welcoming signs that clearly identify the reading room can help. Even removing the reading room door altogether sends a strong message that the room is not off-limits.
Location, and Patient Centered Care
As healthcare evolves towards patient centered care, and fee for service reimbursement models are reconsidered, radiology must be ready to demonstrate value beyond rapid report turnaround and low cost. Unfortunately, face-to-face interaction has been marginalized by the combined forces of PACS and teleradiology proliferation, ubiquitous clinical viewing, ever-increasing productivity pressures, and our societal tendency to use email, video chat and text. As a result, many reading rooms are relegated to the basement and other remote locations. This is a practice that must end if radiologists desire to be considered part of the healthcare team.
Reading room location, also part of the Tertiary Zone introduced earlier, can increase a radiologist’s visibility and facilitate in-person consultation. Whether relocating the reading areas to central locations in the radiology department, or embedding a reading room in a sub-specialty clinical area, enabling convenient and efficient communication has both clinical and business ramifications. The proximity enables face-to-face communication to occur with less disruption to productivity. Opportunities to speak reinforce expertise and assist in continuous learning. Loyalty is also fostered, creating long-term business relationships that can result in more referrals. Overcoming the technical, societal and political barriers to this behavioral change is a challenge that must be confronted. Until radiologists are paid to consult, options must be explored to efficiently increase a radiologist’s visibility, and enable face- to-face consultation, without impacting physician productivity.
Research recently performed at the University of Colorado3 explores the impact of reading room location on radiologist-referring clinician communications, and highlights possible opportunities. Allison Tillack, PhD, lead researcher on the article indicates, “We wanted to understand the impact of proximity on communications and visibility. We decided to embed breast radiologists in our Breast Center, and musculoskeletal radiologists in the Orthopedic Clinic, and observe bi-directional phone and face-to-face communications with their referring providers. As a point of comparison, we looked at similar communications between body and neuro-radiologists, and their referring providers.” In the end, Dr. Tillack observed a statistically significant increase in the number of visits to the embedded radiology groups vs. the remote groups. The study shows that proximity clearly increases the frequency of interaction. Nonetheless, physician leaders play an important role in changing staff behavior by setting an example for their department.
Quantifying the productivity and workflow benefits of reading room location, may not be practical for every institution. The time consuming nature of workflow timing studies limits the ability to quantify the efficiency gains enabled by good design and location. In lieu of formal studies, feedback should
be gathered from a broad range of constituents, including the subspecialty groups, both before and after changes to reading environments are made, so that the effects of any changes can be understood and opportunities for continuous improvement can be identified. Brian Petersen, MD, acknowledges that embedding the reading room may not be practical for all sub-specialties, nor for private practice radiology. “Musculoskeletal radiology, women’s imaging and interventional radiology may be great places to start. For others the use of Skype and screen sharing can enable a virtually embedded opportunity that goes beyond the benefits of a phone call.”
Prepare for the Future
Reading environment renovations should not be viewed as an opportunity to merely purchase new furniture. They must be approached holistically, and address environmental, layout, and location-based considerations to ensure the changes support the strategic goals of a radiology department. Furniture decisions must optimize space and flow requirements, while maximizing ergonomics and customization of the Primary Zone for individual radiologists. Reading environment renovations must address equally the needs of the Primary, Secondary and Tertiary Zones, to ensure they are welcoming to referring physicians and patients, easily accessible, and (of course) productive environments for the radiologists.
Three Benefits of an Optimized Radiology Reading Environment:
1.) Enable efficient, healthy, and happy radiologists
2.) Facilitate opportunities to build loyalty and reinforce expertise
3.) Enhance contributions to increased quality of care at lower cost
The issues impacting radiology today are likely to continue, as the healthcare system continues seeking ways to reduce costs and improve quality. In addition to these industry drivers, enterprise and departmental technology will continue to evolve and converge, as have Electronic Medical Records, PACS, RIS and Voice Recognition. The emergence of the Vendor Neutral Archive and Universal Viewers foretell the day when all imaging studies, including visible light, could be read on a single PACS. If the era of personalized and patient centric medicine is to become a reality, many feel that imaging must become centralized and better integrated into treatment decision making.
Radiology departments and private imaging facilities have difficult choices. They can proceed with the status quo and hope their services are not commoditized, or actively show their customers the full range of clinical expertise and consultative value they can provide. Radiology is a service business and today’s reading rooms must make it easy for the radiologist to efficiently provide the highest quality service possible today, while addressing the evolving service needs of tomorrow.
When considering how to meet these needs through redevelopment of reading environments, it is best to engage an organization that understands Radiology and can bring both design and equipment expertise to the table. RedRick Technologies is such a company. RedRick approaches all projects with the goal of first understanding a department’s needs and constraints, and only then suggests solutions that support these needs. This collaborative process extends throughout the design, development and implementation phases of all projects, to ensure success is realized. Changing ingrained behaviors takes time, but Radiology must continue to lead the way technologically and behaviorally.
1. Glazer GM, Rulz-Wibbelsmann JA, The Invisible Radiologist. Radiology 2011; 258:18-22.
2. Tillack AA, Breiman RS, Renegotiating Expertise: An Examination of PACS and the Challenges to Radiology Using a Medical Anthropologic Approach. J Am Coll Radiol 2012; 9:64-68.
3. Tillack AA, Borgstede JP, An Evaluation of the Impact of Clinically Embedded Reading Rooms on Radiologist-Referring Clinician Communication. J Am Coll Radiol 2013; 10:368-372.
4. Gunderman RB, Tillack AA, The Loneliness of the Long-Distance Radiologist. J. Am Coll Radiol 2011; 12:530-533.